Decision Support to Improve Dental Care for Medically Compromised Patients

改善医疗受损患者牙科护理的决策支持

• 批准号: 8214374
• 负责人: James Ryan Fricton
• 金额: $ 39.03万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8214374
• 关键词: Decision; Support; Improve; Dental; Care

DESCRIPTION (provided by applicant): The primary goal of this application is to use health information technology (HIT) to improve the quality and safety of dental care for patients with serious chronic medical conditions. Chronic medical conditions such as diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth) have a profound effect on the quality and safety of dental care, if neglected. Clinical guidelines have been developed for dentists to make practice changes to reduce this risk, but disseminating evidence-based guidelines is not sufficient to change clinical practice. The emergence of electronic dental records (EDRs) in dental offices offers a powerful tool to improve the quality and safety of care by dentists. The use of clinical decision support (CDS) software in EDRs, when integrated with electronic medical records (EMRs), can inform dentists when changes in clinical protocol are needed for patients with medical conditions and provide personalized, evidence-based recommendations to do so. We have recently completed research supported by AHRQ RFA-HS-07-006: Ambulatory Safety and Quality Program (R18 HS017270) using this CDS technology and found that the use of CDS increased dentist use of personalized clinical guidelines by 440% and significantly improved their point-of- care procedures compared with a control group. However, despite this success, the CDS alerts triggered a response by only 25% of all dental providers, leaving 75% as non-responsive to the system. Thus, we plan to extend this research to determine which components of the CDS increase use by more dental providers and be the first to employ a Health Information Exchange, MnHIE, to translate this CDS into use by community dental providers. We will employ a three-arm, 2-year, prospective, group-randomized clinical trial to compare two CDS strategies designed to increase utilization of the CDS and employ MnHIE to access a patient's medical information for use by the CDS. The two strategies compare a Passive Alert CDS that utilizes both dentist and patient reminders, with quick reference to personalized guidelines in the progress notes versus an Active Script CDS that utilizes an active step-by-step script of the personalized guidelines for dentists to follow and document. PUBLIC HEALTH RELEVANCE: The primary goal of this application is to evaluate the effectiveness of clinical decision support that employs an integrated electronic health record (EHR) system that includes an eMedical Record, eDental Record, and a Personal eHealth Record to improve the quality and safety of dental care for patients with chronic illnesses including diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth). If these medical conditions are not identified and addressed in routine dental care, the quality and safety of care is adversely affected. This study will inform dentists of how to use EHRs to improve care for patients.

描述（由申请人提供）：本申请的主要目标是使用健康信息技术（HIT）来改善严重慢性病患者牙科护理的质量和安全性。如果被忽视，诸如糖尿病，心脏病，肺部疾病和引起静脉科（干口）的疾病（干口干）的质量和安全性具有深远影响。为牙医制定了临床指南，以进行实践改变以降低这种风险，但是传播基于证据的指南不足以改变临床实践。牙科办公室中电子牙科记录（EDRS）的出现为提高牙医的护理质量和安全提供了强大的工具。当与电子病历（EMRS）集成时，在EDRS中使用临床决策支持（CDS）软件，可以在需要医疗状况的患者需要更改临床方案的情况下通知牙医，并提供个性化的，基于证据的建议。我们最近完成了AHRQ RFA-HS-07-006支持的研究：使用该CDS技术的AHRQ RFA-HS-07-006：ABSURATONE安全和质量计划（R18 HS017270），发现CD的使用增加了牙医对个性化临床准则的使用增加了440％，并且与对照组相比，使用了个性化的临床准则，并显着提高了其点心。但是，尽管取得了成功，但CDS提醒仍触发了所有牙科提供商的25％的反应，而对系统的75％则无反应。因此，我们计划扩展这项研究，以确定CD的哪些组成部分增加了更多牙科提供者的使用，并成为第一个采用健康信息交换的人MNHie，将此CD转化为社区牙科提供者的使用。我们将采用三臂，2年的前瞻性，组合临床试验来比较两种旨在增加CD利用的CDS策略，并雇用MNHIE来访问患者的医疗信息以供CDS使用。这两种策略比较了使用牙医和患者提醒的被动警报CD，并在进度注释中快速参考个性化准则与使用活动的脚本CD，该指南使用了个性化准则的主动逐步脚本，以供牙医遵循和记录。 公共卫生相关性：该应用的主要目标是评估采用综合电子健康记录（EHR）系统的临床决策支持的有效性，其中包括Emedical Record，Edental Record和个人eHealth记录，以提高牙齿护理的质量和安全性，以针对包括糖尿病，糖尿病，心脏病，肺病，肺病，病毒疗法的慢性病患者（包括慢性病）。如果未在常规牙科护理中确定和解决这些医疗状况，则护理的质量和安全受到不利影响。这项研究将告知牙医如何使用EHR改善患者的护理。